Despite the survival advantage, not all metastatic renal cell carcinoma (mRCC) patients achieve a long-term benefit from immunotherapy. Moreover, the identification of prognostic biomarkers is still an unmet clinical need.
This multicenter retrospective study investigated the prognostic role of peripheral-blood inflammatory indices and clinical factors to develop a novel prognostic score in mRCC patients receiving at least second-line nivolumab. The complete blood count before the first cycle of therapy was assessed by calculating neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and systemic inflammation response index (SIRI). Clinical factors included pre-treatment International Metastatic RCC Database Consortium (IMDC) score, line of therapy, and metastatic sites.
From October 2015 to November 2019, 571 mRCC patients received nivolumab as second- and further-line treatment in 69% and 31% of cases. In univariable and multivariable analyses all inflammatory indices, IMDC score, and bone metastases significantly correlated with overall survival (OS). The multivariable model with NLR, IMDC score, and bone metastases had the highest c-index (0.697) and was chosen for the developing of the score (Schneeweiss scoring system). After internal validation (bootstrap re-sampling), the final index (Meet-URO score) composed by NLR, IMDC score, and bone metastases had a c-index of 0.691. It identified five categories with distinctive OSs: group 1 (median OS - mOS = not reached), group 2 (mOS = 43.9 months), group 3 (mOS = 22.4 months), group 4 (mOS = 10.3 months), and group 5 (mOS = 3.2 months). Moreover, the Meet-URO score allowed for a fine risk-stratification across all three IMDC groups.
The Meet-URO score allowed for the accurate stratification of pretreated mRCC patients receiving nivolumab and is easily applicable for clinical practice at no additional cost. Future steps include its external validation, the assessment of its predictivity, and its application to first-line combinations.
Therapeutic advances in medical oncology. 2021 May 18*** epublish ***
Sara Elena Rebuzzi, Alessio Signori, Giuseppe Luigi Banna, Marco Maruzzo, Ugo De Giorgi, Paolo Pedrazzoli, Andrea Sbrana, Paolo Andrea Zucali, Cristina Masini, Emanuele Naglieri, Giuseppe Procopio, Sara Merler, Laura Tomasello, Lucia Fratino, Cinzia Baldessari, Riccardo Ricotta, Stefano Panni, Veronica Mollica, Maria Sorarù, Matteo Santoni, Alessio Cortellini, Veronica Prati, Hector Josè Soto Parra, Marco Stellato, Francesco Atzori, Sandro Pignata, Carlo Messina, Marco Messina, Franco Morelli, Giuseppe Prati, Franco Nolè, Francesca Vignani, Alessia Cavo, Giandomenico Roviello, Francesco Pierantoni, Chiara Casadei, Melissa Bersanelli, Silvia Chiellino, Federico Paolieri, Matteo Perrino, Matteo Brunelli, Roberto Iacovelli, Camillo Porta, Sebastiano Buti, Giuseppe Fornarini
Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino of Genova, Largo Rosanna Benzi 10, Genova, 16132, Italy., Department of Health Sciences, Section of Biostatistics, University of Genova, Genova, Italy., Department of Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK Cannizzaro Hospital, Catania, Italy., Medical Oncology 1 Unit, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy., Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy., Medical Oncology Unit, IRCCS Policlinico San Matteo, Pavia, Italy., Medical Oncology Unit 2, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy., Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy., Medical Oncology Unit, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy., Division of Medical Oncology, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy., SS Oncologia Medica Genitourinaria, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Department of Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, University of Verona,Verona, Italy., Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino of Genova, Genova, Italy., Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano CRO-IRCCS, Aviano, Italy., Medical Oncology Unit, Department of Oncology and Hemathology, University Hospital of Modena, Modena, Italy., Niguarda Cancer Center, Grande Ospedale Metropolitano Niguarda, Milano, Italy., Medical Oncology Unit, ASST - Istituti Ospitalieri Cremona Hospital, Cremona, Italy., Oncologia Medica, Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy., U.O. Oncologia, Ospedale di Camposampiero, Italy., Oncology Unit, Macerata Hospital, Macerata, Italy., Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy., Medical Oncology Unit, ASL CN 2, Alba-Bra, Italy., Department of Oncology, Medical Oncology, University Hospital Policlinico-San Marco, Catania, Italy., Department of Medical Oncology, Università Campus Bio-Medico of Roma, Rome, Italy., Medical Oncology Department, University Hospital, University of Cagliari, Cagliari, Italy., Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Napoli, Italy., Medical Oncology Department, Santa Chiara Hospital, Trento, Italy., UOC Oncologia Medica, Istituto Fondazione G. Giglio, Cefalù, Italy., Medical Oncology Department, Casa Sollievo Della Sofferenza Hospital, IRCCS, San Giovanni Rotondo, Italy., Department of oncology and advanced technologies AUSL - IRCCS Reggio Emilia, Reggio Emilia, Italy., Medical Oncology Division of Urogenital & Head & Neck Tumors, IEO, European Institute of Oncology IRCCS, Milano, Italy., Division of Medical Oncology, Ordine Mauriziano Hospital, Torino, Italy., Oncology Unit, Villa Scassi Hospital, Genova, Italy., Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Firenze, Firenze, Italy., Medical Oncology Unit, University Hospital of Parma, Parma, Italy., Department of Oncology, IRCCS, Humanitas Clinical and Research Center, Rozzano, Milano, Italy., Department of Diagnostics and Public Health, Pathology Unit, University and Hospital Trust of Verona, Verona, Italy., Medical Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Chair of Oncology, Department of Biomedical Sciences and Human Oncology, University of Bari 'A. Moro', Bari, Italy., Medical Oncology Unit 1, IRCCS Ospedale Policlinico San Martino of Genova, Genova, Italy.